Journal de mycologie medicale最新文献

{"title":"The impact of immune recovery and treatment duration on disseminated histoplasmosis consolidation therapy in AIDS patients","authors":"Antônio Mauro Barros Almeida Júnior ,&nbsp;Lisandra Serra Damasceno ,&nbsp;Antônio Alberto Bastos Mota Filho ,&nbsp;Brayon Freire Blanquett Vidal ,&nbsp;José Olivan Soares de Almeida Júnior ,&nbsp;Pedro Henrique Barbosa Sales ,&nbsp;Terezinha do Menino Jesus Silva Leitão","doi":"10.1016/j.mycmed.2024.101503","DOIUrl":"10.1016/j.mycmed.2024.101503","url":null,"abstract":"<div><h3>Introduction</h3><p>The present study investigated the impact of immune recovery and the duration of antifungal adherence in the consolidation phase of disseminated histoplasmosis (DH) in acquired immune deficiency syndrome (AIDS) patients living in a hyperendemic area in northeastern Brazil.</p></div><div><h3>Material and Methods</h3><p>Sixty-nine patients with DH/AIDS, admitted to the São José Hospital between 2010 and 2015, who continued histoplasmosis consolidation therapy at the outpatient clinic were studied. The follow-up duration was at least 24 months.</p></div><div><h3>Results</h3><p>Sixty-eight patients used itraconazole 200–400 mg/day or amphotericin B deoxycholate weekly during the consolidation phase, and six patients relapsed during follow-up. The overall median duration of consolidation antifungal use was 250 days [IQR 101 - 372]. Antifungal withdrawal by medical decision occurred in 41 patients (70.7 %) after a median of 293 days [IQR 128 - 372] of use; 16 patients discontinued by their own decision, with a median of 106 days [IQR 37 - 244] of therapy; three patients had no information available, and nine continued on AF therapy. The median CD4+ <em>T</em>-cell count in the group without relapse was 248 cells/µL [IQR 115–355] within 6 months after admission; conversely, in the relapse group, the median cell count remained below 100 cells/µL. Irregular adherence to highly active antiretroviral therapy (HAART) was the leading risk factor associated with relapse and death (<em>p</em> <em>&lt;</em> 0.01).</p></div><div><h3>Discussion</h3><p>The regular use of HAART, combined with immune recovery, proved to be highly effective in preventing relapses in DH/AIDS patients, suggesting that long-term antifungal therapy may not be necessary.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101503"},"PeriodicalIF":2.2,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural disasters and the rise of zoonotic diseases: A case of post-earthquake disseminated cryptococcosis in a dog","authors":"Ezgi Sababoglu Baytaroglu ,&nbsp;Volkan Ipek ,&nbsp;Halil Ibrahim Gokce ,&nbsp;Leyla Elif Ozgu Ayozger ,&nbsp;Berkay Olguner","doi":"10.1016/j.mycmed.2024.101501","DOIUrl":"10.1016/j.mycmed.2024.101501","url":null,"abstract":"<div><p>Cryptococcosis is a systemic zoonotic disease that is challenging to diagnose based on clinical findings in cats and dogs due to the nonspecific nature of its clinical presentation. This case report aims to document the first confirmed case of disseminated cryptococcosis caused by <em>Cryptococcus neoformans</em> in a dog in Turkey and to highlight the potential link between natural disasters such as earthquakes and the emergence of zoonotic diseases in domestic animals. A two-and-a-half-year-old spayed female Cocker Spaniel presented with increased respiratory sounds, skin lesions, facial swelling and enlarged lymph nodes. These symptoms appear to be a complication of <em>Demodex</em> infestation due to the stress experienced by the dog following exposure to a severe earthquake. Diagnostic procedures including cytologic examination, fungal culture and DNA sequence analysis, which confirmed the infection was caused by <em>C. neoformans</em>. Due to the delay in the correct diagnosis of the disease, which, contrary to common data, started as an allergic reaction on the skin and was later diagnosed as a <em>Demodex</em> infestation, the dog died of severe respiratory failure during the treatment with itraconazole. The case highlights the critical role of veterinary emergency and critical care in the diagnosis and management of zoonotic diseases post-natural disasters. It also highlights the need for increased awareness and preparedness among veterinary professionals to address animal health challenges following such events.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101501"},"PeriodicalIF":2.2,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryptococcosis at the university hospital of Marseille: A case series","authors":"Ibrahim Dollo ,&nbsp;Estelle Menu ,&nbsp;Pierre Dudouet ,&nbsp;Camille Aubry ,&nbsp;Coralie L'Ollivier ,&nbsp;Stéphane Ranque","doi":"10.1016/j.mycmed.2024.101500","DOIUrl":"10.1016/j.mycmed.2024.101500","url":null,"abstract":"<div><p>Cryptococcosis is a fungal infection burdened by a high case-fatality rate in immunocompromised patients. Once limited to human immunodeficiency virus (HIV)-infected patients, the epidemiology of cryptococcosis has evolved in recent years and new risk factors have emerged. It is therefore essential to identify these risk factors in order to improve prevention and therapeutic efficacy. We conducted a retrospective observational study including all cases of cryptococcosis between January 2016 and December 2022, diagnosed at the University Hospital of Marseille. During the study period 15 cases of cryptococcosis were diagnosed. Six patients were HIV-infected. Nine patients had one or more comorbidities including liver cirrhosis, type 2 diabetes mellitus, primary immunodeficiency disorder, chronic lymphocytic leukemia and solid organ transplantation. Ten patients had central nervous system cryptococcosis, four had pulmonary cryptococcosis and one patient had extra-pulmonary disseminated cryptococcosis. Of the three patients with liver cirrhosis, two patients died with a post-mortem diagnosis. Our data suggest that emerging risk factors are probably underestimated by clinicians. It emphasizes the need for cryptococcal antigenemia as part of syndromic investigation of any unexplained fever or neurological symptoms in an at-risk patient. Early diagnosis and treatment are essential for patient's survival.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101500"},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1156523324000416/pdfft?md5=10d9c247174ade6c70115a79888e49ac&pid=1-s2.0-S1156523324000416-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mycobiome affects viral susceptibility of skin epithelium","authors":"Liam F. Peterson ,&nbsp;Lisa A. Beck ,&nbsp;Matthew G. Brewer","doi":"10.1016/j.mycmed.2024.101499","DOIUrl":"10.1016/j.mycmed.2024.101499","url":null,"abstract":"","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101499"},"PeriodicalIF":2.2,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Co-occurrence of dermatophyte infection and ichthyosis: A report of 3 cases","authors":"Elisabetta Magnaterra,&nbsp;Elisa M. Difonzo,&nbsp;Manfredi Magliulo,&nbsp;Samantha F. Berti,&nbsp;Massimo Gola,&nbsp;Luigi Pisano","doi":"10.1016/j.mycmed.2024.101498","DOIUrl":"10.1016/j.mycmed.2024.101498","url":null,"abstract":"<div><p>Dermatophyte infections frequently pose diagnostic challenges, especially when occurring alongside ichthyosis, a genetic skin disorder characterized by dry, thickened, scaly skin. This case series outlines three cases where dermatophyte infections overlapped with ichthyosis, emphasizing the complexities in clinical identification and differential diagnosis. Atypical clinical presentations in these cases led to initial misdiagnoses. Ichthyosis, a genetic skin disorder characterized by thickened and scaly skin, creates an environment conducive to dermatophyte settlement, complicating the diagnostic process. The cases highlight the importance of considering fungal infections, even when clinical features deviate from the expected course. A vigilant diagnostic approach, including mycological examinations, is crucial for accurate identification and timely management.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101498"},"PeriodicalIF":2.2,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive phaeohyphomycosis co-infection with Alternaria spp. and Curvularia spp. in a neutropenic host","authors":"Anna Sikora ,&nbsp;Jeffrey Johnson ,&nbsp;Ana Velez ,&nbsp;John Greene","doi":"10.1016/j.mycmed.2024.101497","DOIUrl":"https://doi.org/10.1016/j.mycmed.2024.101497","url":null,"abstract":"<div><p>Phaeohyphomycoses are infections caused by dark-walled dematiaceous fungi. <em>Alternaria</em> and <em>Curvularia</em> are two genera of dematiaceous molds known to cause invasive fungal rhinosinusitis, particularly in immunocompromised patients. Co-infection with two dematiaceous fungi is rarely reported in the literature. This report describes a case of biopsy proven invasive fungal rhinosinusitis with <em>Alternaria</em> spp. and <em>Curvularia</em> spp. co-infection in a neutropenic host. The infection characteristics, microbiologic findings, and treatment are described.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101497"},"PeriodicalIF":2.2,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141582782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic colonization of stray dogs and domestic cats with Trichophyton mentagrophytes II* in Northern Iran","authors":"Vahid Oladzad ,&nbsp;Ayatollah Nasrollahi Omran ,&nbsp;Iman Haghani ,&nbsp;Mojtaba Nabili ,&nbsp;Jacques Guillot ,&nbsp;Seyedmojtaba Seyedmousavi ,&nbsp;Mohammad Taghi Hedayati","doi":"10.1016/j.mycmed.2024.101496","DOIUrl":"10.1016/j.mycmed.2024.101496","url":null,"abstract":"<div><h3>Background</h3><p>Despite changes in the epidemiology of dermatophyte infections, the incidence of fungal infections associated with <em>Trichophyton</em> species still remains high among dogs and cats. The objective of the present study was to isolate and characterize dermatophytes from dogs and cats in Iran.</p></div><div><h3>Method:</h3><p>From December 2022 to May 2023, skin and hair samples were collected from symptomatic and asymptomatic cats and dogs in Mazandaran, a northern province of Iran. The samples were then inoculated into Mycosel™ Agar. Dermatophyte isolates were identified by sequencing the internal transcribed spacer region. Antifungal susceptibility tests were conducted using the Clinical and Laboratory Standards Institute (CLSI-M38-A3).</p></div><div><h3>Result</h3><p>Of the 250 samples collected (from 200 dogs and 50 cats), 20 (from 19 dogs and one cat) (8.0 %) were positive for dermatophyte growth. Based on sequence and phylogenetic analysis, all isolates belonged to <em>T. mentagrophytes</em> II*. Of these positive samples<em>,</em> 14 (70.0 %), 3 (15.0 %), 2 (10.0 %), and 1 (2.0 %) were isolated from asymptomatic stray dogs, symptomatic stray dogs, symptomatic domestic dogs, and symptomatic cats, respectively. Luliconazole and terbinafine displayed potent activity against all <em>T. mentagrophytes</em> isolates, with Minimum inhibitory concentration (MIC) values of 0.016 µg/ml. Miconazole and griseofulvin demonstrated higher MIC (1 and 8 µg/ml).</p></div><div><h3>Conclusion</h3><p>The present study indicated that <em>T. mentagrophytes</em> II* asymptomatic carriage is frequent in stray dogs in Iran. The potential risk to public health needs to be evaluated However, <em>T. mentagrophytes</em> genotype VIII, considered as an endemic and emerging human pathogenic clone in several countries, was not detected during the present survey.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101496"},"PeriodicalIF":2.2,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Easy-to-use imaging-cytometry assay to analyze chitin patterns in yeasts","authors":"Delphine Aldebert ,&nbsp;Bastien Suarez ,&nbsp;François Bettega ,&nbsp;Emilie Boucher ,&nbsp;Cecile Garnaud ,&nbsp;Muriel Cornet","doi":"10.1016/j.mycmed.2024.101493","DOIUrl":"10.1016/j.mycmed.2024.101493","url":null,"abstract":"<div><h3>Background &amp; Aim</h3><p>Pathogenic fungi are a major threat to public health, and fungal infections are becoming increasingly common and treatment resistant. Chitin, a component of the fungal cell wall, modifies host immunity and contributes to antifungal resistance. Moreover, chitin content is regulated by chitin synthases and chitinases. However, the specific roles and mechanisms remain unclear. In this study, we developed a cytometric imaging assay to quantify chitin content and identify the distribution of chitin in the yeast cell wall.</p></div><div><h3>Methods</h3><p>The <em>Candida albicans</em> SC5314 and <em>Nakaseomyces glabratus (ex. C. glabrata)</em> ATCC2001 reference strains, as well as 106 clinical isolates, were used. Chitin content, distribution, and morphological parameters were analysed in 12 yeast species. Moreover, machine learning statistical software was used to evaluate the ability of the cytometric imaging assay to predict yeast species using the values obtained for these parameters.</p></div><div><h3>Results</h3><p>Our imaging-cytometry assay was repeatable, reproducible, and sensitive to variations in chitin content in <em>C. albicans</em> mutants or after antifungal stimulation. The evaluated parameters classified the yeast species into the correct clade with an accuracy of 85 %.</p></div><div><h3>Conclusion</h3><p>Our findings demonstrate that this easy-to-use assay is an effective tool for the exploration of chitin content in yeast species.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101493"},"PeriodicalIF":2.2,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1156523324000349/pdfft?md5=4d8e2d51e08cad8a6ea5d5cce85d468f&pid=1-s2.0-S1156523324000349-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased terbinafine resistance among clinical genotypes of Trichophyton mentagrophytes/T. interdigitale species complex harboring squalene epoxidase gene mutations","authors":"Leila Zahedi Mohammadi ,&nbsp;Masoomeh Shams-Ghahfarokhi ,&nbsp;Zahra Salehi ,&nbsp;Mehdi Razzaghi-Abyaneh","doi":"10.1016/j.mycmed.2024.101495","DOIUrl":"10.1016/j.mycmed.2024.101495","url":null,"abstract":"<div><p>Terbinafine resistance has become epidemic as an emerging problem in treatment of dermatohpytosis. This could be attributed in part to a point mutation in the squalene epoxidase (<em>SQLE</em>) gene. In this study, point mutations in the <em>SQLE</em> gene were studied in <em>T. rubrum</em> and <em>T. mentagrophytes/T. interdigitale</em> species complex as two main causative agents of dermatophytosis. Antifungal susceptibility of clinical isolates of <em>T. rubrum</em> (<em>n</em> = 27) and <em>T. mentagrophytes/T. interdigitale</em> (<em>n</em> = 56) was assessed using the M38–3rd edition CLSI method. The <em>SQLE</em> gene and <em>ITS</em> region were sequenced for all the fungal strains, and the mutation sites and genotypes of the terbinafine-resistant strains were characterized. The results demonstrated that, in <em>T. rubrum</em>, the minimum inhibitory concentration of terbinafine (MIC₅₀ and MIC₉₀) was 0.03 μg/ml, and the geometric mean (G mean) concentration was 0.02. For the <em>T. mentagrophytes</em> complex, the MIC₅₀ and MIC₉₀ were 0.03 and 1.0 μg/ml, respectively, and the G mean concentration was 0.04 μg/ml. Four out of the five resistant strains were <em>T. indotineae</em> harboring the F397L and Q408L mutations, while the last one was <em>T. mentagrophytes</em> genotype VII, which harbors the F397L mutation. <em>T. indotineae</em> was the prominent causative agent of terbinafine resistance, with 80 % of the isolates, and <em>T. mentagrophytes</em> genotype VII was introduced as a new genotype in the terbinafine-resistant <em>T. mentagrophytes</em> complex. Our findings further substantiate the importance of antifungal susceptibility testing in selecting the choice of drug for effective treatment of dermatophytosis and highlight the importance of screening dermatophyte species for point mutations responsible for newly developed resistant strains to improve the current knowledge of overcoming infections caused by resistant species.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101495"},"PeriodicalIF":3.6,"publicationDate":"2024-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antifungal efficacy and immunomodulatory effect of PLGA nanoparticle-encapsulated itraconazole in histoplasmosis in vivo model","authors":"Susana P. Mejía ,&nbsp;Daniela López ,&nbsp;Luz Elena Cano ,&nbsp;Julián D. Muñoz ,&nbsp;Jahir Orozco ,&nbsp;Tonny W. Naranjo","doi":"10.1016/j.mycmed.2024.101494","DOIUrl":"10.1016/j.mycmed.2024.101494","url":null,"abstract":"<div><h3>Introduction</h3><p><em>Histoplasma capsulatum</em> is the etiological agent of histoplasmosis, the most common endemic pulmonary mycosis. Itraconazole (ITZ) is the choice for mild disease and a step-down therapy in severe and disseminated clinical presentations. Drug encapsulation into nanoparticles (NPs) is an alternative to improve drug solubility and bioavailability, reducing undesirable interactions and drug degradation and reaching the specific therapeutic target with lower doses.</p></div><div><h3>Objective</h3><p>evaluate the antifungal and immunomodulatory effect of ITZ encapsulated into poly(lactic-co-glycolic acid) (PLGA) NPs, administrated orally and intraperitoneally in an <em>in vivo</em> histoplasmosis model.</p></div><div><h3>Results</h3><p>After intranasal infection and treatment of animals with encapsulated ITZ by intraperitoneal and oral route, fungal burden control, biodistribution, immune response, and histopathology were evaluated. The results showed that the intraperitoneal administered and encapsulated ITZ has an effective antifungal effect, significantly reducing the Colony-Forming-Units (CFU) after the first doses and controlling the infection dissemination, with a higher concentration in the liver, spleen, and lung compared to the oral treatment. In addition, it produced a substantial immunomodulatory effect on pro- and anti-inflammatory cytokines and immune cell infiltrates confirmed by histopathology.</p></div><div><h3>Conclusions</h3><p>Overall, results suggest a synergistic effect of the encapsulated drug and the immunomodulatory effect contributing to infection control, preventing their dissemination.</p></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"34 3","pages":"Article 101494"},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1156523324000350/pdfft?md5=241e970230a8807799ba4dc0e3213e33&pid=1-s2.0-S1156523324000350-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141412520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}